This book provides a detailed account of disability benefit policies in six countries: Denmark, Britain, Israel, the Netherlands, Sweden and the US. The authors find that policy makers in all countries seem increasingly concerned about the numbers and the cost of people claiming disability benefits. Accordingly, policy makers have attempted to encourage claimants to leave disability benefits (‘increasing outflow’), and to discourage claimants from applying for disability benefits (‘decreasing inflow’). However, only the UK appears to have succeeded in these two policy aims, and there only with respect to new claimants. That said, the chapter by Kemp and Thornton predicts that, even in the UK, there is unlikely to be a substantial decline in the numbers of people claiming disability benefits.

The book is mainly concerned with ‘enabling policy makers to consider national problems in an international context’ (p. v). It provides an impressive amount of statistical material about claimant rates over the past few decades in the countries examined, and manages to demonstrate that the issues are not so simple as policy makers might believe. However, the voice of disabled people in the benefit system is notably absent. As Tauritz and Landheer comment: ‘one important question remains unanswered. What happens to people, who under the current system would be considered disabled, in a system based on a (much) stricter criterion? Do they become active and self supporting? Do they reside in other welfare arrangements? Or do they find their way into disability anyway, but then with more serious complaints?’ (p. 136).

Their point is pertinent, and there is evidence that restricting benefits deepens social divisions, disproportionately affecting the weakest. For example, Claussen (Reference Claussen1998) found that when Norwegian disability pension rules were tightened, ‘women, middle-aged [people], those living alone, those with short education, and applicants with “medically imprecise” diagnoses’ (p. 1) were over-represented among those denied benefit. Kemp and Thornton briefly mention effects of the increasing harshness of Incapacity Benefit (IB) rules in the UK: ‘The number of appeals [against disallowed of benefit] more than doubled between 1999 and 2002 and reached about 60,000 a year by the latter date. . .almost half of all claimants who appeal are successful.’ (p. 158). This represents 30,000 IB claimants per year who now must struggle through a complex appeals process in order to retain the benefit to which they are entitled.

I would have liked to see this collection give greater attention to the social suffering produced by the policy changes documented, which in most cases have not been proved successful in their stated aims of reducing the claimant count and providing greater opportunities for disabled people. As Kemp himself concludes, policy assessment should include an analysis of what happens to people who are excluded from benefits, or who would otherwise have taken up benefits.

Tauritz and Landheer point out that contemporary welfare reforms have signalled a break in ‘the prevailing way of thinking about disability’ (p. 133), representing a shift from disabled people seen as ‘victims’, to disabled people seen as ‘calculating actors’. This is accompanied by an increasingly punitive sensibility. For example, in the UK a campaign is currently running to re-brand ‘benefit cheats’ as ‘benefit thieves’. The autonomy demanded by the disability movement has partially been acknowledged, but only in the sense of policy makers portraying sick and disabled citizens as ‘scroungers’ rather than as ‘unfortunate’. I would have liked more analysis generally of shifting concepts of disability, and how these are linked to social and economic change. Such work already exists in the Disability Studies tradition (e.g. Gleeson, Reference Gleeson1999).

Similarly, there is much work on why the incidence, and/or the diagnosis, of mental illness has increased so dramatically in recent decades. Since mental illness represents a major and growing share of reasons for disability benefit claims, these issues are highly pertinent to the subject matter. In the US, nearly a quarter of all Disability Insurance Awards are now made on these grounds, making this the single largest diagnosis group. Over 40 per cent of Supplementary Security Income awards (for those without sufficient payroll contributions for DI) are made on the grounds of mental disorder. This is against a backdrop of steadily increasing numbers of claims and awards. The collection might have benefited from a chapter reviewing literature that could help to explain these figures.

The collection concludes with the comment that ‘the problem of high levels of disability benefit recipiency in post-industrial societies is a complex and intractable one that is not going to disappear anytime soon’(p. 240). Clearly this is true, and the book provides valuable numerical information detailing this point. It implicitly makes the case that we need to go beyond studying disability benefit regimes in isolation if we want to understand what is initially presented as a relatively recent social policy problem.